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Srinivasan A, et al. MMWR 60: 2011; CDC BHSN 2010 Data Summary; Umscheid CA, et al. Infect Control Hosp Epidemiol. 2011; 32:101-114. Scott RD. Division of Healthcare Quality Promotion, CDC, 2009.
CHG/SS
M/R Silver/Platinum/ Carbon (Silver Iontophoretic; Vantex)
Hydrocath Assure (BD) Benzalkonium AMC Thromboshield (Edwards) Benzalkonium Heparin Multistar
Miconazole/Rifampin (Vygon)
M/R
C C/S
S/C/P
Staphylococcus epidermidis
Spangler & Moss, Arrow International
Pseudomonas aeruginosa
Spangler & Moss, Arrow International
S/C/P
C/S
M/R
C
Candida albicans
C/S C
S/C/P M/R
CH/SS: Poor activity vs Acinetobacter, Stenotrophomonas, Enterobacter
Medline search of articles with “meta-analysis” in title, 2007-2011
Meta Analysis
Quality of Reporting of Meta-Analysis (QUORUM) guidelines
Silver Alloy (0.58)
Silver Iontoph (1.98)
Silver Impreg (0.93)
BenzChl (1.0)
BSI
Colonization
Silver Alloy (1.21)
Rif/Micon (0.14) Casey AL, et al. Lancet ID, 2008
Ramritu AJIC 2008
Scatter plot of 29 studies (BSI vs. colonization) Spearman Correlation coefficient: r = 0.63, r2 = 0.4; P = 0.003
Casey AL, et al. Lancet ID, 2008
0.29
0.47
0.68
2.3%
5.9%
4.2%
Do antimicrobial-coated catheters prevent BSI?
1
2
S. aureus 1st & 2nd generation CH/SS CVCs
S. epidermidis 2nd generation CH/SS CVC
Bassetti, et al AAC 2001 Fey et al, ICAAC, 2000
(58 explanted CVCs)
Duration of activity of M/R appears to be greater than CH/SS
Chest, 2004
Crit Care Med, 2011
Veenstra DL, et al. JAMA 1999
Shorr AF, et al. Chest 2003
Marciante KD, et al. AJIC 2003
Veenstra DL, et al. JAMA 1999 “…the use of chlorhexidine-silver sulfadiazine impregnated catheters in patients at high risk for infection reduces the incidence of CR-BSI and death and provides significant saving in costs.”
Shorr AF, et al. Chest 2003 “Utilization of antiseptic and antibiotic-impregnated CVCs represent an attractive alternative for prevention of CRBSIs and may lead to significant savings. … the RM CVC performs better financially.”
Marciante KD, et al. AJIC 2003 “CVCs coated with M/R are cost effective for patients catheterized for at least one week and lead to overall cost savings when patients are catheterized for 2 weeks or longer.”
Conclusions from Cost Effectiveness Studies
Health Technology Assessment, 2008
Crit Care, 2009
GND X M/R * CH/SS SPC
(MRSA)
Durability vs MRSA
Uncoated M/R CH-M/R CH/SS
Spectrum of Activity
Uncoated M/R CH-M/R CH/SS
MRSA P.aer C. albicans C. glabrata
Kaplan Meier analysis of colonization
Walz, et al. Crit Care Med, 2010
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